Wednesday, December 17, 2014

In Blindness—
the 1995 novel by the Portuguese (1998) Nobel laureate for literature Jose
Saramago— an epidemic of “white blindness” mysteriously renders all people,
save one, blind, and chaos and cruelty ensue. Written without much punctuation
the reader must, much like a therapist trying to make sense of the patient’s
narrative, discern who is speaking to whom and about what. Blindness teems with allusions to our metaphorical blindness, such
as people “behave as if they were afraid of getting to know each other.” Saramago speaks to the sanctity of
reciprocity: “I have no right to look if the others cannot see me,” and to the
wrath – “some will hate you for seeing” –
of being the one who sees what all others are blind to (or disavow, like
a parent who attacks the seeing child’s reality). There are moments of
tenderness, such as when two blind lovers reunite: “how did they recognize each
other…love, which people say is blind, also has a voice of its own,” and
moments of despair when one’s true self goes unrecognized: “what good would it
do her beautiful bright eyes…if there is no one to see them.”

Because all, save one, are blind, there can
be no witness, yet some manage to find affective sharing when the blight can
“convert strangers into companions in misfortune.” Despair overtakes many in
this dark novel for “what meaning do tears have when the world has lost all
meaning.” Even the one who is spared this affliction is incredulous to what
becomes of those around her: “what shocked her was her disappointment, she had
unwittingly believed that…her neighbors would be blind in their eyes, but not
in their understanding.”

If blindness is, in part, the blindness to the need of
the other, then I am reminded of Stuart Pizer’s 2014 paper The Analyst’s Generous Involvement: Recognition and the “Tension of
Tenderness” which eloquently joins with and departs from Emmanuel Levinas’
idea of putting the suffering other above oneself. If one is to lean towards
another’s need, one must first see (recognize) the need. Pizer takes Sullivan’s
concept of the ‘tension of tenderness’: “the analyst’s recognition of a need or
an affect state in the patient evokes an internal tug constituting the analyst’s
need to provide for what has been recognized.” He writes, “An instinctual tug toward
tenderness, or a spirit of generosity, in response to a recognized state of need
in the Other is an inherent feature of our functioning attachment system.”

But
how does a blind person see the Levinasian strange, transcendent, unfathomable ‘face’
of the other? Pizer sees generosity as instinctual, but expects Levinas to “reject
instinct in favor of a subjectivity open to interruption, surrender, and
awakening by an encounter with the Other.” Pizer continues, [we are] “wired to
seek community, relational embeddedness, or ‘we-ness.’” Generosity sometimes
requires of the analyst, per Corpt, an “unsettling re-evaluation and openness
to amending any and all aspects of analytic practice in light of the patient’s
forward edge strivings.” Pizer learned from his grandfather the healing power of
the affectively resonant, witnessing presence of someone who recognized his
need, and accepted him just as he was. Saramago notes its opposite, “Blindness
is also this, to live in a world where all hope is gone.” That is, no hope of
being seen, recognized, contained and accepted.

Tuesday, December 9, 2014

The task of the analyst is to help the patient learn
about himself (discover the many facets of himself, if you will), not to impose on the patient the necessity to
prove the analyst’s pre-learned theories about human behavior. The analyst,
then, has no corner on ‘truth’ and cannot privilege her perspective over that
of the patient’s psychic reality. Instead, both analyst and patient struggle to
negotiate a working relationship toward discovery. Faltering, fumbling, rupturing,
both then strive to upright and repair what has been lost in the relationship. No
matter how both analyst and analysand are implicated in the co-creation of the transference,
countertransference, or resistance, whatever the patient does is always in the
service of trying to heal himself. The patient tests the analyst for trustworthiness,
commitment, and circumspection. Make no mistake, that whatever the outcome—whether
impasse, acquiescence, failure to improve, getting worse, or stopping treatment
– it is always the analyst’s responsibility. The analyst welcomes in, then must contain what has been welcomed.
The analyst’s failure to monitor interactions between patient and analyst, to
recognize and correct misattunements, can have dire consequences. While both
take responsibility for the discourse, any failure lies on the shoulders of the
analyst alone.

Tuesday, December 2, 2014

Because we all seek to maintain [or create anew] a sense
of individual meaning, Lafarge writes that disruption of our sense of self can
lead to the wish for revenge, “a
ubiquitous response to narcissistic injury.” Revenge “serves to represent and
manage rage and to restore the disrupted sense of self [and restore the]
internalized imaging audience [the other].” Narcissistic injury is a disruption
to meaning and self value and to the story of one’s experience. In
efforts to reestablish meaning and to construct a story, as well as create a
witness to one’s story, the avenger uses anger and revenge to consolidate early
experiences (a time when the “imagining parent” [like Bion] helped construct the
infant’s mind with meaning and with its representations of self and others).
Communicating experience and constructing its story is also present in the
revenge. It is a way of being seen and heard and helps maintain the tie to the lost,
imagining parent. Thus, revenge can ward off object loss [Searles] and hatred
can be an early form of object constancy. “Giving up the wish for revenge
requires the avenger to recognize the rage and helplessness that are warded off…[and]
involves acknowledgement of a transient disruption of self experience” that they
accompany.

Lansky tells us that shame gives rise to rage as a strategy to protect one’s sense of self from the awareness of helplessness, abandonment, betrayal. Sometimes, clinically, it is easier to analyze the visible
rage and resentment than its underlying shame, but it is the detailed
exploration of shame that sheds light on its unbearableness. When one’s sense of self
is chronically disrupted from the betrayal by needed and beloved others,
attachment is at risk. All future attachment is at risk, for who wants to be
duped again, subject to humiliation and shame? The disrupted self, in valiant
efforts to reconstitute a self representation that can be lived with, may need
to withdraw and isolate, project, omnipotently control, split, or retaliate.
The latter, as revenge, can seemingly restore a sense of power and
effectiveness as well as protect against awareness of vulnerability. Revenge also
protects against the uncertainty of forgiveness. Only awareness of loss and its
mourning can circumvent the need to humiliate the other, leading to forgiveness
both of self and other.

Wednesday, November 26, 2014

In the wake of Ferguson, MO’s Grand Jury decision not to
indict a white police officer’s killing of a black teenager, residents
expressed their concerns. Whether police brutality or self defense, black young
men are in danger, aggravated by lack of accountability on too many sides. One
mother tearfully asked, “What am I to tell my son when he grows up?...You try
to have hope.” Another woman tearfully expressed a more universal need, “We just hope for one time that our lives
will matter; that somebody will see that our lives are valuable.” This latter plea speaks to the human motivation to be seen, to be recognized for who we are and
still be accepted.

As we gather around the Thanksgiving table with our
families of origin and the families we have made, may we take a break from
seeing what we expect and, instead, look anew from an other’s point of view, accepting
her or him just the way they are, and, hopefully, being accepted in return.
What might we be thankful for? That in the best of relationships we are loved, warts
and all.

Thursday, November 20, 2014

Unlike Kohut, who believed in a unitary self and thought
health was an increased cohesiveness in one’s sense of self, Bromberg says that
we all exist in a multiplicity of self states, each with its own memory,
experience, and unconscious. “Health is
not integration. Health is the ability to stand in the spaces between realities
without losing any of them.” (p.186), that is, it is simultaneous awareness
of these many discrete selves. The sense
of a unitary self, writes Bromberg, is an adaptive illusion. Dissociation of
certain self states, with their untenable affects (such as shame) occurs in all
of us, often in response to the traumas of misattunement, misrecognition, or
attacks on our reality. Bromberg recommends that analysts learn to see the validity of a patient’s psychic reality alongside their own, careful not to claim ownership of arbiter of reality. In this capacity to see both realities, space is made to construct consensual meaning. Their relationship is continually renegotiated.

Sometimes the only way to access dissociated experience
is through enactments which can painfully draw the analyst into the early
object relations of the patient. Sometimes these enactments additionally allow the patient to see his impact on the analyst. Enactments are

…an example of what Levi (1971)
called “a powerful though perverted attempt at a self cure” (p.184). It involves
a need to be known in the only way possible – intersubjectively—that is
different from the old and fixed patterning of self-other interactions, a version
of the situation that led to the original need for dissociation. (p.172)

For a patient in analysis to
look into his own nature with perceptiveness, and to utilize creatively what is
being enacted, there must exist a simultaneous opportunity for the patient to
look into the analyst’s nature with
an equivalent sense of freedom and security. (p.176)

In the clinical situation, those patients with the most
dissociation, often called personality disorders, cannot resonate with
interpretations which address conflict because, until contradictory self states
are in simultaneous awareness, the contradiction/conflict cannot be 'seen' by the patient.
Because psychic reality varies by self state, an issue already explored in one
self state may come up again later in another self state. As one candidate noted to herself as her patient spoke, "Didn't we already go over this!" In this 'Groundhog Day' phenomenon, and the going over and over the same ground, is what I like to call 'the joy of Sisyphus,' and the candidate asks, "So where's the joy?"

From
STANDING IN THE SPACES: Essays on Clinical Process, Trauma, and Dissociation
(1998). Psychology Press. New York, London; Chap. 12, Shadow and Substance.

Tuesday, November 18, 2014

Gerhardt’s rich paper on the intersubjective contribution
of envy elucidates the part played by the mother’s (and analyst’s) failure to
identify with the infant (later, analysand). Unlike Klein who saw envy as
primary and related to aggression and the death instinct, Gerhardt frames envy
in terms of refused desire. She sees envy as secondary to thwarting of this
wish to be at one with the object, to both have and be the object, to matter to the object, as when the mother
refuses to accept desire from the child as well as fails to help the child feel
desired by her. The failure of the mother to adapt to the needs of the infant and
her failure to see the infant’s demands for recognition as legitimate, renders
her unable as well to experience maternal identification with the infant’s
(secondary) envy. When the analyst (or mother) dissociates her own disavowed
envy, dependence, and shame, she cannot identify with the patient’s split off
self-states, and is less able to contain and transform them for the patient’s
use. Gerhardt’s patient felt contained when Gerhardt invites and sustains a
kind of one-ness, in part, through the analyst’s mutual identification with her
patient, rendering horrible affects less terrifying.

Gerhardt writes that envy results when the “normal
identificatory processes have gone awry,” and quotes Benjamin: “when desire to
identify goes unanswered, envy takes its place.” [I think of penis envy and
father’s rejection –or mother’s prohibition— of the female child’s
identification with the father.] Envy, for Gerhardt, is an attempt at “denial
of difference” and “repudiation of dependency” in response to the mother’s
failure to identify with and manage the infant’s expelled and intolerable
states, in particular those in which the infant (later, analysand) feels abject
and defective, full of shame. Envy,
then, is also secondary to shame. Gerhardt also invokes Bion’s “protesting the separation
between knower-known” [which calls to mind the humiliation engendered in the
patient when the analyst insists on being the only ‘knower’ in the dyad]. [As
an aside, she reminds us that Bion had noted that the mother’s failure to
contain the infant’s fear evokes in the infant “nameless dread.”]

Oelsner takes the classic object relations approach,
taking umbrage with Gerhardt seeing aggression and envy as secondary, and
recommends the repeated analysis of aggression. He reminds us that Bion
conceived of envy as an attack on linking. Envy destroys otherness by denying,
through projective identification, recognition of separateness. Ornstein, on
the other hand, as a self psychologist, agrees with Gerhardt that envy is
secondary (this time, to empathic failure of participation of the analyst’s
subjectivity and rejection of patient’s efforts) and sees Gerhardt’s eventual
capacity to empathize with her patient— by giving up her “decoding
interpretations” (experienced by the patient as “counter-attacks”) and by recognizing
her part in thwarting the patient’s desires. Ornstein recommends seeing what
transpired between them not as an attack by patient on analyst, but as a
forward edge in terms of being able to make a demand of the analyst that the
patient could not make as a child on her mother.

Saturday, November 15, 2014

If Freud said our personal ideologies are our “private
religion” (convictions with unfaltering ritualization of behavior, repetition
compulsion, if you will), Shaw adds that our private religions spring from our
attachment story for we are all subjugated by our internal objects. Shaw defines traumatic narcissism as the need to defend against dependency, for
dependency is intolerably shameful and humiliating, and must be disavowed. Instead,
dependency and neediness is seen in the other for the traumatic narcissist has
everything within the self and needs no one. Traumatic narcissism is a
relational dynamic requiring both the narcissist and its object to be
subjugated. The easiest target is its child.

While all parents may sometimes attack the reality of
their children, self aggrandize the child’s accomplishments, and have hope that
the child will make up for their own failures, the traumatic narcissist can
never admit fallibility, can never apologize, and continually attempts to control and erase the subjectivity
of their children. This is the cumulative relational trauma. The traumatic
narcissist despises the child’s neediness, yet, paradoxically, any attempts by
the child towards independence and agency are punished (by withdrawal or
retaliation) for the narcissist requires the child to be the container for
shameful neediness, Bateson’s classic double bind. This child, shamed for its
dependence (and what is a child but dependent?), made to feel selfish and
greedy, recognizing that only the attachment figure’s needs are deemed valid, grows up to identify
with the hated, but much needed, aggressor, an intergenerational transmission
of traumatic narcissism.

Objectification of the child by the traumatic
narcissist is an absence of recognition,
or a presence of negation. In analytic love, the therapist envisions the
potential that cannot be realized, much like the good enough parent sees what
the child can become. The children of traumatic narcissists, when they become
our patients, demand not only that we recognize their trauma, but that we
recognize our own disavowed traumatic narcissism! What a dangerously fraught
journey for both patient and analyst as we struggle together toward freedom
from the tyranny of our inner objects.

Tuesday, November 4, 2014

Lansky delineates shame and guilt for us, and refers to the
classical literature to make his points. He describes shame as resulting from failure to live up to one’s aspirations
(ego ideal) and it signals fears of loss of relationship or separation and/or
fears of exposure with concomitant humiliation. Weakness, defectiveness,
vulnerability are all words patients might use to describe their shame. When
shame is triggered, it may result in impulsive action, such as the intimidation
of others (e.g. domestic violence) or compulsive binging, as one tries to
regain control over one’s disorganizing sense of weakness. Guilt, on the other hand, results from failure to live up to
superego expectations and can be used to defend against shame, for it gives a
sense of action (some committed transgression) rather than the helplessness or
powerlessness which evoke shame.

Shame is a hidden affect (there is shame in being ashamed), but
Lansky says that it is not the affect itself which is hidden, but the consequences
(social annihilation) of the affect. His idea alludes to the relational nature
of shame, though when shame is consequent to failure to live up to one’s ego
ideal it does not necessarily involve the other. Freud had previously noted
that neurotic symptoms were an attempt to hide from awareness that which would
evoke painful affect, as are defenses. (Not until 1926, in Inhibitions, Symptoms, and Anxiety,did Freud made explicit his signal theory of affect.)

Freud relegated shame to conflicts around toilet training, but
Erickson spoke closer to the problem in his stage Autonomy v. Shame and Doubt,
which is contemporaneous with Freud’s anal stage. Freud places guilt, and fear
of retaliation (by castration), in the oedipal phase, whose heir, as you may
recall, is the superego. Klein puts shame in the paranoid-schizoid position
when, in addition to fear of attack and destruction, the expectation of one’s vulnerability
being exploited by others with the intent to humiliate exists. Klein places
guilt in the depressive position, which for her precedes the oedipal phase,
when the infant becomes aware of the injury it inflicts on the mother. Kohut “divorced
the notion of shame from any notion of conflict”, but Lansky opines that had
Kohut linked ‘fragmentation anxiety’ in terms
of its failure to live up to an ego ideal of maintenance of self image and self
respect, Kohut might not have been so ostracized by the classical
psychoanalysis of his day.

My favorite nod to shame comes from Tomkins; He proposed that shame results from an interruption of joy.
[How felicitous is that to remind us to meet our children’s joy with our own!]Many
of the patients I see have indeed experienced the failure of their ‘love affair
with the world’ to be met with attuned parental joy. Analysts, too, are called upon
to meet our patients in the same direction affectively, though somewhat
modified and without the disorganizing intensity, if lucky.

What Lansky might have elaborated more is the analyst’s shame, a powerful impetus to our dissociation, as when
the struggle of our patients with their helplessness, their humiliation, and
fears, trigger our own. He does note that “the shame of others makes us feel
about ourselves what we do not like to feel: vulnerable, weak, powerless,
dependent, contingent, disconnected, and valueless” and that “the emerging
shame of the other stirs up our own difficulty bearing shame, our helplessness,
and our anxiety that we may prove defective and fail in our professional roles
because we, in facing the patient's incipient experience of shame, will be
found to have nothing effective to offer.”

Monday, October 27, 2014

Additional important lessons for individual therapists to be taken from participation (procedural learning; 'the medium is the message') and understanding of group process as demonstrated by Roth on Oct 25, 2014 include:

1. The assignment (or acquisition) of authority (power).
The group facilitator often asked permission of the group and individuals to make comments on certain behaviors, e.g. pairing, before actually making said comments. He also, on occasion, made it clear that these were his point of view and open to review by the group with the possibility of a different outcome.

2. The use of data that was present and available for all to make use of.
The facilitator skillfully used exact words and phrases from group participants to call events of individuals to the entire group's attention, always reminding the group that one member may have been designated by the whole group to hold or contain something for the entire group (e.g. loss, trauma, sadness, aggression). Unfortunately, for some, this method was too exposing, felt to be too personal, and, therefore, narcissistically injurious, something the individual therapist strives to avoid but inevitably finds her/himself inflicting. Since injury is inevitable, what is valuable is the reparation. Reparation cannot occur if admitting injury is further humiliation. Likewise, the disappearance of the consultant, like the end of a session, feels, to some, being 'kicked to the curb' and we have no next session with the facilitator. The group will have to make use of the consultant through object constancy.

Sunday, October 26, 2014

Many psychoanalysts eschew group therapy, but yesterday
the Tampa Bay Psychoanalytic Society, Inc had an experiential look at group
processes provided by its guest 'speaker' Jeffrey Roth, MD. Based
on Wilfred Bion’s basic assumptions about groups, as taught in the U.S. by the A.K.
Rice Institute for the Study of Social Systems, we had firsthand experience with
the impact about how our behavior and unconscious processes organize experience
intrapsychically, interpersonally and en masse.

Bion posited three basic assumptions for group behavior:

1)Fight/flight, where the group hostilely engages
authority

2)Dependency, where the group does nothing
but expect that the all powerful authority will provide for everything, and

3)Pairing, where the group deems authority
as incapable of providing what is needed and so two in the group are ‘elected’
as the pair who will now make provision of group needs.

A fourth group, the work group which functions to accomplish
tasks, is often thwarted by these three basic assumptions, while paradoxically
illuminating (through consultation) what the work group needs to address.

How did our use of group process help us in our work as
individual therapists? We procedurally learned that everything that emerges
(data) is useful and has meaning, contributing to the richness of the dyadic
interaction, if the therapist welcomes it in, and can make use of it, instead
of being bored as if nothing ‘deep’ is being related. All data signals what
would like to be taken in or pushed away. Groups function around ‘BART’, boundaries, authority, roles, and tasks. How
these four entities are negotiated by the group are experienced, studied,
elucidated, and may be transformative. While the group experience is transformative,
and may continue to be so, old roles and skill sets (leader, scapegoat, etc)
remain available. We are made up of multiple selves, after all.

Sunday, October 19, 2014

The Orphanage (2007), directed by Juan Antonio Bayona, is about the
unconscious, inadvertent, intergenerational transmission of trauma and it was
deftly discussed today by Adriana Novoa, PhD at the Return of the Repressed Film Series. She notes that most horror films place what is
horrifying ‘outside’ or into the ‘Other’, but that this film places the horror
inside the characters, and inside the audience through its emotionally resonating
themes.

Laura (Belen Rueda), her husband Carlos and their adopted, seven
year-old son Simon (Roger Princep) move to Laura’s childhood orphanage which she hopes to restore
and reopen to care for five more children. Simon does not understand his
mother’s need to take in more children. He has been told neither that he is
adopted nor that he is HIV positive, but is understandably angry when he overhears this. When Laura and Carlos host a festive garden
party for potential wards, Simon
disappears. Laura begins to suspect that the orphanage is haunted. Consulting a
medium (Geraldine Chaplin), she learns that a number of orphans had been poisoned there. Perhaps Laura repressed any knowledge of Tomas who had drowned,
a few days after Laura is adopted, as the result of a cruel prank played on him
by the other orphans. These culpable children disappeared soon after.

The audience can speculate that Laura’s dissociation of
her early traumas (loss of childhood playmates, for example) made it difficult for
her to recognize the losses Simon experiences. Her refusal (out of terror) to
recognize her own son behind the mask, as well as his anger at her ‘lies’, lead
to his unfortunate demise. His final attempts to communicate himself to her (through
banging from the cellar where he is trapped) fail just as his previous
communications about his discoveries of Tomas’ anguished world fail to get
Laura’s understanding. Her misrecognition of Simon’s world is fatal. Laura’s
unconscious wish to restore the lost (murdered) five children by caring for an
additional five differently-abled children is thwarted. Likewise her
unconscious knowledge of the accidental death of Tomas is recreated, poignantly,
in Simon’s accidental death. Only in Neverland, in death, can the lost children
be reunited with Wendy, now grown. Nowhere is the return of the repressed more
dangerous.

Wednesday, October 15, 2014

Knox gives us a neurobiological explanation for the
origins of shame. Should the mother register disgust for her infant or her infant’s
agency, the infant’s sense of self and of agency is linked –through the insula
(where mirror neurons may activate disgust) and the midline structures (where
the sense of self is thought to be encoded) –with shame. A mother who cannot
tolerate her infant’s distress may cause the infant to procedurally learn to
hide pain in order to protect the attachment. This may result in a fear of love or Fairbairn’s schizoid
personality, where shame has been linked to relationship.

A sensitively attuned mother is less likely to be
disgusted by her infant and his needs. Winnicott speaks of the primary maternal preoccupation as a
necessary requisite to allow for development of sufficient attunement of mother
for baby. In doing so, we can infer that, he advocates for safeguarding the
necessary space for the pregnant woman and new mother to acquire the necessary
sensitivity to the needs of her infant. Should there be a failure to attune to
the infant’s needs, the infant is in danger of a disruption of going on being, and of annihilation anxiety. Winnicott notes
that in the early days of life, it is the mother who must identify with the
baby, and not vive versa.

Lycia Alexander-Guerra

Tampa, FL

Knox:

“…the need for the therapist to facilitate a process
of disruption and repair (Beebe & Lachman 2002) in which the patient
has an opportunity to correct the therapist's misattunements (Benjamin
2009)”

I give an example from today’s session.

The client, in 8th year of
therapy with me, tried to correct my misattunement saying that I had to listen [to]her
need more, that is, she did not need my mirroring, but rather my opinion
different [from] hers. While explaining that to me I asked her what she was
experiencing my mind focused on. She replied, “I know you listen to me [with]
so [much] concentration that I get love and affection.” Then gradually she
started crying. After a little [while], I asked, ‘What was the correlation with
your tears?’ She told me, “I asked for your opinion different [from] mine [and]
you give me a different focus on me, compared to the not being focused [on by]
my parents. How can I be so arrogant?”

I think that was an example of disruption and
repair where a part of herself was correcting me, paying attention to a self
state I was ignoring, while another self state of hers was being repaired but
was partially ignored by her!

Winicott:

“What the mother does well is not in
any way apprehended by the infant at this stage. This is a fact according
to my thesis. Her failures are not felt as maternal failures, but they act as
threats to personal self-existence”

I am not sure I agree with such a
thesis. Although there is limited consciousness or self to perceive the mother
as good enough, or bad enough, I think there is sufficient attachment-based
relational need that is encoded preverbally via the body. If the mother attunes
well or not well with the baby’s attachment needs, regulation/dysregulation is
experienced via the body.

Thursday, October 2, 2014

I like, as always, the poetic rhythm Winnicott offers to
the reader! As I was reading Winnicott’s The capacity to be
alone, I questioned whether the author was trying to make
explicit a narcissistic developmental issue or a schizoid developmental
trauma? In my view, the latter was more likely.

The capacity to be alone is presented as a prerequisite of the capacity to be
alone with your self. While he goes very deep in helping us understanding the
issue I think the paper misses addressing the other side of the coin, that is,
the capacity not only to be with your self but also the capacity to be withoutthe other. This is in my view different
from the former one. I did not see something written in the paper
regarding dissociative phenomena, especially about those clients who are caught
in between, partially being able to stay alone, and, simultaneously, stay
without the other.

These clients can stay in
silent moments in treatment for a while and give a glance to the analyst. They
can stay partially alone in the presence of the analyst but cannot stay equally
alone without his presence (that is evident via the glance). Many times as well
these clients are alone psychically in the presence of the analyst: they are involved
with the discussion but you sense their body is frozen (not in excitement
attachment). This is an indication, I think, that they can be partially alone in
the presence of the analyst, and with themselves,but not alone without him.

Winnicott, D.
(1958). The capacity to be alone. Int.J.Psa., 39:416-420.

Wednesday, October 1, 2014

· The
capacity to be alone is a highly sophisticated phenomenon and has many
contributory factors. It is closely related to emotional maturity

· Ego-relatedness
refers to the relationship between two people, one of whom at any rate is
alone; perhaps both are alone, yet the presence of each is important
to the other

· Gradually,
the ego-supportive environment is introjected and built into the
individual's personality, so that there comes about a capacity actually to
be alone.

· If
the patient cannot play, then something needs to be done to enable the patient
to become able to play, after which psychotherapy may begin. The
reason why playing is essential is that it is in playing that
the patient is being creative.

· There
is no need for the therapist to organize chaos all the time. Sometimes that
behaviour covers and substitutes a real need for rest and empathic listening.

For example I have a patient deeply emotionally detached [who]
tries to understand how to handle relationships. For that reason I proposed [to]
him to join a group and indeed he accepted. He is in the group for 3 months and
now he feels angry with other members because they talk and they do not allow
time and space for him and others. When I asked him (in individual session)
what do you want from others when they see that you are not talking? He replied
"to give space to my silence. I do not want [them] to tell me anything but
I need [them] to respect my silence and accompany me in that. I want to stay
all in silence for some minutes in order to feel what I feel, to touch the
depth of my sorrow that I cannot otherwise demonstrate."

At the previous session I "played", as Winnicot
says, with him. I showed him a video from the web. In that video a man was
seeing a woman from a distance and then tried to reach her by walking [across] a
street. A car hit him, some glass from a window broke [and reached the woman].
However, they did not reach each other. The message was that all of that was
only in the man’s fantasy. While my client was watching the video he cried and
I did not ask him anything except one comment, "It seems that you at least
reached out to something." So I was company, a silent company to his noisy
loneliness.

Winnicott, D.
(1958). The capacity to be alone. Int.J.Psa., 39:416-420.

Tuesday, September 30, 2014

As we know, trauma increases blood flow to the amygdala while
decreasing perfusion to the hippocampus with the effect that procedural,
emotional and sensory memory take place without the benefit of symbolization
in language and without contextualization (one physiological explanation for
dissociation). This phenomenon informs how clinicians can work with experience that has no words. The narrative approach assumes that symbolization is already present. Trauma, including the trauma of chronic misattunement, can cause chronic autonomic
nervous system activation (affecting respiration, heart rate, perspiration,
muscle tension, etc) with its emphasis on sensory not symbolic representation.

Bucci proposed a multiple code theory of emotional processing,
three systems of emotional schema: the subsymbolic
(perceptual, sensory), symbolic imagery
– both non-verbal— and the symbolic
(verbal). These three systems are
separate, but through the relational attunement and secure attachment with
caregivers, who use their own emotional and cognitive schema to help children name,
accept and regulate their emotional states, connections between the three are
forged. In somatization, subsymbolic somatic schema are activated but are dissociated,
never linked, or have lost their link to symbolic representations.

Taylor contrasts conversion disorder with somatization
disorders. In the former, symbolization is intact and emotions are represented,
and symptoms are the result of repressed (by an active ego), conflictual
fantasies. On the other hand, somatization, writes Taylor, lacks underlying
fantasies, and emotions are poorly representable, sometimes called alexithymia.
(The ego is made helpless by dissociation.) Two different therapeutic aims
ensue. For conversion symptoms, Freud made conscious the unconscious conflict through
interpretation, but with somatization symptoms, says Bucci, what is required is
a strengthening of connections between the subsymbolic and symbolic.

Gottlieb gives a nice history of the way different psychoanalysts
have conceived of psychosomatic symptoms. They argue causality, meaning, and treatment.
Students might enjoy contrasting Janet, Freud and MacDougall, as well as distinguishing
la pensee operatoire from alexithymia. Many agree that somatization involves
dissociation. Where does a child turn when the very people who are to help regulate
distressing feelings are also their source? Hopefully, we will, in class, add
from our clinical experience the relational intersubjective component of psychosomatic
disorders, with the understanding that caregivers powerfully affect one’s
ability to symbolize, mentalize, and see the other as an equal center of
subjectivity.

Monday, September 29, 2014

Winnicott and Knox both speak to the infant’s developing
sense of self and both are relational in the import for this ascribed to the
environment. Winnicott wrote that
only in play, being creative, can the individual discover [become] the self. Being
creative is not about products of the body or mind, but rather a feature of
total living. Play, for Winnicott, meant living in the potential space [sometimes
called transitional space or the third], “an area that is intermediate between
the inner reality of the individual and the shared reality of the world that is
external…” Winnicott exhorts the therapist to create an environment which
allows for this third space in which to play. The good enough therapist
provides repeated experiences that allow the patient to trust as well as enters
into the arena of play with the patient.

While Winnicott recommends refraining from getting in the
patient’s way to self discovery, for example, by the therapist being more
interested in being clever, the one who knows or makes sense of, than in
following the patient’s formlessness, his example seems to belie that his
patient came alive from her formlessness (and his restraint from
interpretation). Instead, she seems to complain repeatedly that she did not
matter to him and only became enlivened after
he actually shared the contents of his mind with her. [The mother develops her baby’s mind, and co-creates meaning,by having him in her mind, and by engaging the infant in reciprocal turn-taking.] It was when
Winnicott reflects back, nearly two hours later, his patient’s experience to her does her experience
take on meaning for her. [It befuddles me how Kohut failed to cite Winnicott when writing about mirroring.]

Knox writes that the infant’s sense of self first comes in to being by the meaning attributed to its actions by its mother. A child internalizes [develops its sense of self through] its mother’s attributions, positive or negative. Negative attributions, internalized, then, can generate a sense of a deficient self, with its concomitant shame. To bulwark a diminished self, grandiosity and narcissism may be self-protective as the child struggles to remain alive emotionally.

Wednesday, September 24, 2014

Today The United Nations Security Council resolved
unanimously to stem the flow of foreign terrorist fighters across borders, allowing Secretary General Ban Ki-Moon, in his address to the Council, to note how “enemies of
faith…brutalize women and girls” and “target and slaughter minorities.” He also said, “Eliminating terrorism
requires international solidarity …[W]e must also tackle the underlying
conditions…The biggest threat to
terrorists is not the power of missiles. It is the politics of inclusion…and
respect for human rights…Missiles may
kill terrorists, but good governance kills terrorism…societies… free from
suffering, oppression and occupation.”

And Melinda Gates highlighted the pressing need for gender
equality (e.g. in education and health) around the world. [Despite the gender
inequality unaddressed] in the Civil Rights movement, the tenet that ‘no one is
free until we are all free’ still rings
true, and women and girls have waited a long time for equality. Perhaps the wait is approaching closer its end.

Monday, September 22, 2014

Scott Ferguson, PhD, Film Professor at USF, spoke to the
“pleasure” of horror films—indulging viscerally, sensually-perceptually, and
affectively in the “abject”— and about the pleasures and horrors of media.
Evoking Marshall McLuhan, he noted that egalitarian access to information media
destabilized roles and place, frightening some, while simultaneously allowing
new freedoms for connections. How are we to negotiate being with one another in
these new ways, all the while uncertain, our privacy threatened? There are
ethical challenges to consider [and only Aidan pauses to ask about how our
choices affect others].

Ferguson asked us to consider how a film engages the
cultural moment, socially and historically, not merely to think psychologically
about relationships and characters, but to additionally think about how these
are also conditioned by electronic media. The winged shape of a ‘samara’ seed enables
the wind to carry it farther away from the parent tree. Thus estranged from its
origins, Samara – adopted, then killed, then killer— speaks to the futility of
recapturing the nuclear family, if one ever existed.

Symbols in this film confound the viewer, first
suggested, then disconfirmed, offered, then undermined. There is the ring left
by a coffee cup or that formed by the mouth of the well, Samara’s tomb, and, of
course, the fatal telephone ring. A ring can symbolize wholeness, closure,
where beginning and end meet, but in this film there is no resolution. A
lighthouse which is meant to give protective warning, leads to more danger. The
island isolates and connects. Where medium is viewed as conduit, agency, means,
The Ring depicts multi-media:
telephones, boats, water.

Much was made of reproduction, whether the copying of
the VHS tape or human procreation, both leading, in this film, to a deadly
end. One audience member asked why do humans seek to procreate, particularly
when children are so disruptive to their parents’ lives. Anna kills her adopted
daughter Samara. Thinking about the
relational context depicted in the film, how are the children allowed to
develop and then engage the world? Neither Samara nor Aidan were wanted by
their fathers, Richard and Noah, respectively. Despite the exterior trappings
of a normal home, there was no space for Samara to be herself. Samara was a
child wanting to be heard, calling out to be saved. Her adoptive parents
constrained her, not just in the barn, but in every way. Samara’s agency frightened her parents. She
had to produce herself, come in to being herself. Parents who disempower their
children, dehumanize them, creating monsters.

The audience also appreciated the cinematography,
comparing its chaotic black and white scenes to Picasso’s Cuernavaca, the isolation of the island buildings to Hopper, and
the grayish-greenish imagery to our surreal nightmares. At other scenes, color was hyper-saturated, like neon invading our senses.

So many perspectives brought together, what a rich
discussion followed the viewing of The
Ring yesterday!

Saturday, September 20, 2014

The 2014-15 Film Series “Return of the Repressed” (horror
films) opens Sunday,
September 21, with The Ring
(2002), directed by Gore Verbinski, and discussed by USF Film Professor Scott
Ferguson, PhD, and myself. The Film Series is a
collaboration between the Tampa Bay Institute for Psychoanalytic Studies and the Tampa Bay Psychoanalytic Society. I am no fan of horror films, but I will
discuss at the film’s showing how The
Ring, [as does Case 39, to be
shown on Feb. 15, 2015] exemplifies our fear of our children. Scott, I think, will be discussing our fear of
technology.

Because an infant’s sense of self first comes in to being
by the meaning attributed to its actions by its mother, a child is vulnerable
to its mother’s negative attributions. If she sees his hunger as greedy, or his
natural exuberance as evil, the infant senses her disapproval and rejection. [I
once heard a mother attribute her infant son’s fists to his wish to assault
her. The ‘fists’ of a baby are consequent of the grasp reflex, with which all healthy
infants are born--perhaps left over from our more furry ancestors clinging to
their mothers’ backs.] These negative attributions are internalized and are
thought to become part of one’s sense of self (in the cortical and subcortical
midline systems via connections to the insula. Mirror neurons in the insula are triggered
when one observes disgust on another’s face. )

When mothers are unable to regulate their own distress,
the distress of their infants becomes unmanageable. Depressed mothers ‘shut down,’ turn away, or ‘close’
their faces to their infants. [We are told in The Ring, that Anna was unable to carry her own biological child
and was institutionalized.]

Mothers who eschew their children’s strivings convey that
the child’s agency is unacceptable. Should a parent’s repressed or dissociated
(disavowed) fears and impulses be unconsciously projected onto their children,
the child becomes ashamed of himself, his impulses, and his agency. He sees
himself as bad, destructive, unlovable. [Perhaps Samara is living out what her
adoptive parents saw in her, that which was disavowed in themselves.]

We hope that local readers will join us Sunday, Sept 21
at 2pm. Here is the entire series roster:

the 2014-2015 Film Series

Horror films: “Return of the Repressed”

Psychoanalysis is interested in art, such as film,
because it assumes two levels of meaning, one manifest, the other hidden. It is
the latter unconscious meaning which resonates with the viewer. Horror films,
in particular, express the Freudian motivations (drives), and the fear of
aggression and libido, which are often communicated in symbols. Some say it is
these unconscious motivations, threatening to become manifest, which terrorize
us, including the fear of the discovery of the unknown, whether it be the
monster lurking in the shadows or in the unconscious. What contemporary analysts
understand to be more horrific, though, is loss of connection and meaning, when
one finds oneself utterly devoid of embeddedness and place.

Tuesday, September 16, 2014

The body remembers. Early traumatic experience, whether
occurring before the hippocampus comes ‘on-line’ or dissociated from symbolism
by decreased blood flow to the otherwise functioning hippocampus, is
procedurally ‘learned’ and stored by affect and perceptual senses. Chronic
thigh pain may be the only link to the pain of childhood sexual abuse, the
smell of a particular cologne and its consequent headaches the only connection
to herald long ago parental tirades. We
feel. We panic. We don’t remember the events. It may take countless hours of
psychotherapy before integration and words allow voice to be given to those
early threats to sense of self.

In Theaters of the
Body (1989) Joyce MacDougall writes that psychosomatic illness results from
the body reacting to a psychological threat as though it were a physical threat
due to lack of awareness of our emotional states when being threatened, so
seeking psychological treatment is very tricky for both patient and therapist.
While one may wish to be free of psychological (and psychosomatic) symptoms, we
must remember that these symptoms have been, since childhood, a best possible
attempt at bearing the unbearable. Our patients wish and fear the giving up of
these symptoms for these symptoms helped (in earlier times) with psychic
survival. They may also be the only clues we have to early traumas.

Kradin, from a Jungian perspective, provides an
introduction to the psychosomatic illnesses. He states that the psychosomatic
symptom is “a symbolic communication by the suffering self to caregivers…a cry for help in hope that someone will
respond, and a method of repelling others as an expression of unconscious
dread.” Early caregivers regulate infant distress and give meaning to infants’
bodily sensations. The failure of symbol formation in people suffering with
psychosomatic disorders speaks, in part, to the inadequate regulation between
mother and infant. Kradin highlights (from Noyes) the anxious maladaptive
attachment style where (from Driver) etiology of at least one disorder, CFS, is
speculated to include “inadequately internalized maternal reflective function,
affect dysregulation, and diminished psyche-soma [Winnicott] differentiation.”
Other events often found in the histories of patients with psychosomatic disorders
are “a parent with physical illness, a history of family secrets, and childhood
maltreatment” including emotional abuse. Kradin reminds therapists that our aim
is treatment of the disordered self and
not symptom reduction. “[S]ymptoms are ‘real’, whatever their cause” and
“healing begins only once caregivers have disabused themselves of the notion
that patients are responsible for their disease.”

Monday, September 15, 2014

1.For Auerbach a narcissistic individual, in
contrast, the self is experienced as cohesive and vital at the cost of the object's becoming
fragmented and lifeless,and vice versa. That is why one who has capacity for
self-love can love others,and why narcissistic individuals are profoundly invested
in others but only insofar as others are mirroring them or are capable of
being idealized. Terms like part object, selfobject, and transitional object
express the narcissistic patient's representational and relational difficulties.

2. Auerabach using
a Piagetian framework according to Bach, states that narcissistic patients have difficulty in establishing
equilibrium between subjective awareness (i.e., the immediate, nonreflective
immersion in the experience of self as a center of thought, feeling, and
action) and objective self-awareness (i.e., the awareness of self, including
thoughts, experiences, feelings, actions, etc., as an object among other objects
and a self among other selves).

3. Auerbach states
that shame is a core issue in the effort to understand narcissism. "that shame is an ineluctable
consequence of objective self-awareness, and that objective self-awareness, the eye
turned inward to discover in the midst of interest or enjoyment hidden
faults and defects, is the core of shame.

4. Shame emerges,
in this second perspective, as the mediating term in the dialectic of subjective and objective self-awareness but
at the same time is also at the core of the resistance to psychoanalytic
psychotherapy and psychoanalysis by containing a desire not to be exposed.

5. Psychological health, adequate self-esteem, involves
not an absence of shame but a capacity to tolerate the shame that inheres in
individuality. In other words, shame ensures that selfhood, no matter how well
established, always remains a locus of conflict.

6. Bach notes, provide alternative but illuminating
developmental perspectives on this narcissistic dilemma, and suggest that
narcissistic disturbance involves not so much a misallocation of libido as a problem in the
representation of objects and object relations.

7. Subjective awareness, as I call it, is a state in
which we are totally into ourselves and our feelings while the rest of the world is
in the background—that is, a Romantic or Dionysian state of mind.

8. For Bach we are all both Dionysians and Apollonians,
Romantics and Classicists, but one difference lies in our preferred
mode of being and also in our abilities to make the transition or oscillate back
and forth, flexibly and appropriately, between these two states.

9. For Bach there
are 2 types of narcissism: the inflated sadistic type who presents with open grandiosity and an unconscious sense
of worthlessness and the deflated masochistic type who presents with open
feelings of worthlessness and an unconscious sense of grandiosity.
The inflated type with open grandiosity exists primarily in a state of
subjectivity, concerned only with himself and unable to be objective about his
aspirations, but unconsciously he feels worthless and self-critical. The
deflated type with open feelings of worthlessness exists primarily in a
state of objective self-

awareness, masochistically denigrating and criticizing
himself as if he were some hostile outside observer, but unconsciously he may
feel quite special or grandiose.

10. But, what occurs as the child matures is not just
better regulated and more appropriate oscillations between subjectivity and
objectivity or between self and other but rather a more complex
synthesis, a blending and interpenetration of the two in the transitional area so
that they are no longer simply dichotomous.

Sunday, September 14, 2014

It was fortuitous to have had John Auerbach, PhD in Tampa
yesterday speaking at the local (Tampa Bay) Psychoanalytic Society, for the
Institute begins its Fall Semester this week and we are reading on Wednesday, in
the Narcissism and Shame course, a review by Auerbach. Speaking to Bach’s ideas
on the subject, Auerbach highlights the disruption of reflective self-awareness
in those with narcissistic disturbances.

Bach tells us that the grandiose, inflated narcissist
exists in a state of subjectivity (increased subjective awareness, ‘it’s all about
me’), with the sense of worthlessness in the background. Subjective self-awareness
alternates with objective self awareness in which the narcissist denigrates the
self, feeling deflated and worthless. Auerbach notes the paradox of these two
states of reflective self-awareness: “subjective awareness increases the sense
of aliveness but decreases objective knowledge of self, and objective self-awareness,
by increasing knowledge of one’s place (and smallness) in the world, decreases
self esteem.” This very paradox is what causes in the narcissist fragmentation
of the sense of self. Interpretation (of,
for example, the difficulty) is experienced “as an attack upon the self, a
narcissistic injury.” Instead, the transitional space between objective and
subjective can be utilized to develop and maintain self cohesion.

Self reflection is the ability to view oneself as if looking
on (objectively) from the outside. Bach notes two states of self awareness: subjective
and objective, and how difficult it is to move easily between them if early
caregivers did not help regulate the transition between them smoothly enough to
prevent abrupt shifts in autonomic and limbic systems’ firing. Auerbach, too,
in his review of Nathanson’s The Many
Faces of Shame, tells us that sudden interruption of excitement or joy can
induce shame, the hallmark affect of narcissism, and Auerbach writes, “shame is
the ineluctable consequence of objective self awareness…” And isn’t that what psychoanalytic therapy partly
endeavors to do, to increase objective self-awareness, all the while inadvertently
engendering shame? This semester, we endeavor to discuss how to minimize shame
in our patients and ourselves as we struggle to become.

Thursday, August 7, 2014

If he had lived a few years more, my father would be 93
years old today. He was a newspaperman for
his home town paper for half a century, in the days when that was a profession
in which facts were just that, and judiciously weighed. He also wrote opinions:
the op-ed page, a column, and book reviews. It would be no exaggeration to say
I grew up in a home with 10,000 books. No one questioned his word or his
character. He seemed to know everything. The older kids in the neighborhood
came to him to settle their disputes. My older daughter, in her eulogy of him, said,
“Grandpa was Google before there was Google.”
I remember one time from when I was very small he loaded up the family
station wagon with my brother and me and a bunch of boys from the neighborhood and
drove us to the local drive-in movies. A boy said, “Mr. Alexander, we can all
hide in the back, under the blankets, so you don’t have to pay for everybody.”
But my father, of course, paid for every child. That is one of my earliest
memories and it shaped my idea of my father. It also taught me something about
honesty and integrity. As analysts, we strive daily toward honesty, a heady
ambition. Though dead, he remains a role model.

My father had a remarkable capacity to recite poetry off
the top of his head. This was one of his favorites, from his childhood:

Wednesday, July 30, 2014

I call your attention to the Pulitzer-prize winning journalist and best-selling author Ron
Suskind ’s latest book, a memoir, Life, Animated, A Story of Sidekicks,
Heroes, and Autism because the
remarkable journey of his family to find their way to connect with their son Owen
reminds me of some of the very best we strive for in the psychothera-peutic relationship. Owen, as present in 1/3 of the cases of the
millions of children with autism, has regressive autism, that is, he appeared
to develop normally but then began, in his case before his third birthday, to
lose speech and social skills. Owen, without necessarily comprehending, memorized
the entire scripts of the Disney films that he for so long and continued to watch, and he could do all the characters’ voices, too. Initially, the Suskinds discouraged as non-productive
Owen’s perseverative obsession with Disney animated characters. But in their
attempt to look for a way into the psychological life of their son, cut off
from the rest of the family, they decided to use what Owen presented to them as
the key to make their way in, and his entire family became proficient in Disney
voices. Suskind would even recommend dancing in front of the TV screen if need be.

I take this as good advice, jumping into the rabbit hole as
it were, with some of our most unreachable patients, even those with psychosis,
instead of trying to make them conform to our ideas of how to communicate a
narrative; to use what is presented and find within its inexplicable vehicle
some nidus around which together to build meaning [meaning, after all, arises
from within connection]; To bend the frame as needed, dance in front of the
screen, if there exists any hope to reach the unreachable. In other words,
welcome in, welcome in, with an attitude of ‘If you want, I want to,’ for without connection, there is a deadness to
our being together.

To animate both their lives, Suskind and his wife, and their older son Walt, decided to go where
Owen was. What they previously had thought was a prison for Owen has become a
pathway to communication between them. Remembering from the Lion King’s ‘Remember
who you are,’ Suskind asks Owen, ‘Who are you, Owen?’ and Owen, remembering,
too, replies, ‘Your son.’

Sunday, July 27, 2014

The local psychoanalytic professional society offers
every year a discussion group as part of its extension division. This year, the
readings will all come from Philip Bromberg’s 1998 book Standing in the Spaces, Essays on Clinical Process, Trauma, and
Dissociation. In its introduction, and addressing the psychoanalytic
process, Bromberg grapples with the human ability to allow “continuity and
change to occur simultaneously.” He posits that the self is not unitary but
that the mind is a “configuration of shifting, nonlinear states of
consciousness in an ongoing dialectic with the necessary illusion of unitary
selfhood.”

Bromberg emphasizes the role of dissociation—a result of
trauma— as equally significant and more powerful than repression and conflict,
in shaping the psyche. Psychoanalysis builds
a bridge between dissociated (not-me) self states of the mind and thus, transforming
it, allows for “the experience of
intrapsychic conflict.” It enhances “a patient’s capacity to feel like one self
while being many.” Dissociation, both normative and pathological, exist in both
participants and the patient and analyst purposefully confront and engage each
other’s (and their own) multiplicities and nonlinear realities as they organize
their relationship.

In moments of intense affective arousal, when parents are
unable to reflect upon a child’s mind, both staying in the appropriate
affective experience with the child and bringing the parent’s new perspective
to bear, the child may be “traumatically impaired in his ability to cognitively
process his own emotionally charged mental states…and thus own them as ‘me’.”
Bromberg continues, “[P]sychological trauma can broadly be defined as the
precipitous disruption of self-continuity through invalidation of the internalized
self-other patterns of meaning that constitute the experience of ‘me-ness’.”
This threat to self is experienced as annihilation anxiety. Dissociation
protects the sense of self continuity by keeping at bay traumatic disruption.
Unfortunately, safety of this trauma based personality requires one to be at
the ever ready for disaster such that one can never feel safe even when one is.

One poignant example of dissociation exists in the
schizoid patient whose dissociation, Bromberg writes, is “so rigidly stable…that
is tends to be noted only when it collapses.” To protect itself from annihilation
anxiety, the schizoid personality prevents spontaneity by keeping a boundary
between the inner and outer world such that things remain predictable and
controllable. “The struggle to find words that address the gap that separates us
is the most potentially powerful bridge between the patient’s dissociated self-states…Once
the words are found and negotiated between us, they then become part of the
patient’s growing ability to symbolize and express in language what he has had
no voice to say.”

Sunday, July 20, 2014

It is the subject who desires. Bromberg [blog post July
6, 2014] already alluded to anorexia as renunciation, or inability to own,
desire. Developing a cohesive sense of self, or subjectivity, requires in infancy
and childhood attunement which serves to regulate physiological and affective
experience. Affect, once regulated, can be integrated with experience (as
episodic memory) such that accumulation of memory gives a continuity over time and
the experience of a sense of self. Subjectivity also includes agency, which
begins with that of an infant able to engage the caregiver in cooing repartee
or the toddler who can command the shared delight of a caregiver when a presented
(shared) dust bunny or acorn. Benjamin
notes it is the shared joy, the toddler at discovery, the mother at the toddler’s
joy, not the presented thing itself, that brings communion.

As Winnicott knew and Kennedy notes: reality [and
meaning] arise out of shared interaction between two subjects, that is,
socially constructed, neither already present nor individually created, but of
both. Nietzsche, too, posited that the subject is not given, but invented,
added up. Society as well arises then from the result of subjective meaning. Meaning,
co-created with the caregiver (having a place in a relational world), gives one
a sense of having the right to be here in the world, and be here as a welcomed
subject. At the same time, there is the dilemma, what Husserl called “the paradox
of human subjectivity” because we are both subjects (with desire) for the world
and objects (of desire) in the world.

Bromberg, like Hume, denies a singular subject or self, but
instead sees us made up of a collection of self states, variably integrated, or
“a collection of different perceptions.” Kennedy describes a kind of thinking “which
takes account of a fleeting and ambiguous nature of our subjective life as it
exists in relation to a world of other subjects, and which cannot be tied down
to the centralised and solitary ego.” Kennedy, evoking Benjamin, “points to
the need to use a model of the mind that incorporates both positions
[intrapsychic and intersubjective] without privileging either.

Kennedy tells us that Kojeve noted Hegel’s introduction
of the desiring subject, distinct from the knowing subject, for Kojeve

emphasised that the person who contemplates and
is absorbed by what he contemplates, that is the ‘knowing subject’, only finds
a particular kind of knowledge,knowledgeof the object. To find the subject,desireis needed; the desiring subject is the
human subject. As explored by Kojeve, what is essentially human aboutdesireis that the subject desires not just
an object, not even thebody, but theother'sdesire. One desires theother'sdesire. The movement between the subject and theotherin a constant search forrecognitionof their desires constitutes humanreality.Desireis the essential element reaching
beyond the individual subject to the othersubject. These descriptions seem to
capture an important element of the psychoanalytic relationship, in which the
subject's desires, or wishes,dreamsand
fantasies are thematerialon
which analyst and patient work.

Kennedy writes that “With the analyst not being directly
available, the analytic setting sets in motion a complex search for the human
subject.” This got my colleagues and I arguing about the use of the couch and
whether the analyst out of sight promotes the subjectivity of the patient, as
if in order to be a subject, the other must be an object— which, to my mind, is
anti-Hegelian (Hegel notes that the subject must be recognized by an equal
other in order to be a fully experienced subject). Kennedy notes that we must
own desire of the other as object, and that being a subject also entails the capacity
to take up different positions without become frozen or fixed in any.Our welcoming in varying self states of the patient,
then, can confound the patient who, himself, finds these dissociated parts
unwelcome (and vice versa for the analyst). Included in the patient’s (or our)
disavowal is the difficulty of allowing the other to make an impact.

Moreover, intersubjectivity, adds Kennedy,

refers not only to the sharing of experiences but
also to issues of meaning surrounding these relations, the nature of the
orientation to theother, how one understands theotherand is affected by theotherand the place of humandesire, as
well as the nature of the social world.

Kennedy’s paper is
rich in contemporary ideas, but I wondered in his clinical material— where he
writes that Mrs. A could not find her own subjectivity— if her complaints did
not also include that she could not find her analyst’s (as had been the case
with her mother’s) subjectivity either.

Welcome!

Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studiesor, as it is conveniently known, T-BIPS. We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens. We look forward to a spirited dialogue with you.Lycia Alexander-Guerra, M.D.TBIPS PresidentGabcast! Welcome! #3

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In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.